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Center for
Social Innovation

Center for Social Innovation

Social Entrepreneurship

The JaipurKnee Project II: Scaling up the Business

Academic Case Study by:
Stefanos Zenios, Lyn Denend
Published: 2012
[photo - JaipurKnee]

When a team at Stanford University accepted a challenge to design a low-cost prosthetic knee joint that could be produced locally for use in the JaipurFoot Organization’s clinics across India, the students thoroughly researched the problem, including the limitations of the existing knee joints the clinics were using. Over time, they created an innovative knee joint that met the unique needs of developing world amputees, which they called the JaipurKnee.

By late 2011, the JaipurFoot Organization had fitted 3,000 patients with the JaipurKnee joint in its clinics across India. Given its charitable mission, the JaipurFoot Organization had provided the JaipurKnees and the procedures at no cost to the patients. It locally manufactured the joints in its machine shops to keep its dependence on outside partners to a minimum and to directly control the inventory it needed. While Sadler and his teammates viewed their early experience with the JaipurFoot Organization as incredibly valuable, the team decided that it wanted to make its low-cost knee joint available to amputees beyond the Jaipur clinics in India. Unfortunately, they discovered significant market barriers. The total addressable market of 30 million amputees in countries around the world sounded like a lot, but the majority of these individuals are extremely poor, located in remote areas, and difficult to reach using current distribution channels. There were no well-established channels for reaching the millions of amputees who could benefit from the product, primarily because they were served by thousands of small, scattered clinics. This mini-case study describes how the JaipurKnee team developed a strategy to access its target market and scale up its business.

[Read Case]

This story is part of the Global Health Innovation Insight Series developed at Stanford University to shed light on the challenges that global health innovators face as they seek to develop and implement new products and services that address needs in resource-constrained settings.  

Acknowledgements: We would like to thank Joel Sadler, Vin Narayan, and Krista Donaldson of D-Rev for their participation. This research was supported by the National Institutes of Health grant 1 RC4 TW008781-01.

Photo credit: ReMotion Designs

Impact Review: Sustaining a Good Idea Without a Standalone Business Model

Academic Case Study by:
Stefanos Zenios, Lyn Denend, Julie Manriquez
Published: 2012
[photo - Impact Review]

While enrolled in a course focused on entrepreneurship, a team of Stanford students set out to create a platform for developing-world healthcare providers that would facilitate improved information sharing about high-impact, affordable solutions in the maternal and infant health space. The result was Impact Review, an online knowledge-base with a user rating system to aid the target audience in making more informed purchasing decisions based on user-generated commentary. 

When the team members graduated from Stanford, they had to determine what was next for Impact Review. They considered whether Impact Review could become a sustainable (although socially-minded) business. The primary model they explored was to generate revenue by posting advertisements on the site. However, in order to appeal to advertisers, the site would need to generate a high volume of regular traffic. Attracting and retaining such a large number of visitors during the company’s early stages did not seem feasible. They also contemplated the idea of establishing Impact Review as nonprofit and using donations to underwrite the organization’s ongoing operations. However, because all four teammates had accepted full-time jobs upon graduation, they worried about their ability to raise adequate contributions over the long term. Another option was to find one or more established entities that could benefit from Impact Review’s technology and get them interested in acquiring the technology. Not only would this ensure that the mission of Impact Review was carried forward, but it could help the platform take a giant leap forward if it was acquired by a company with a large established base of users in the target market. This mini-case study describes how the Impact Review team explored its options and the solution it developed to ensure the sustainability of the technology.

[Read Case]

This story is part of the Global Health Innovation Insight Series developed at Stanford University to shed light on the challenges that global health innovators face as they seek to develop and implement new products and services that address needs in resource-constrained settings.  

Acknowledgements: We would like to thank Nupur Srivastava for her participation. This research was supported by the National Institutes of Health grant 1 RC4 TW008781-01.

Photo credit: Courtesy of Impact Review

IDRI: Neglected Disease R&D with a Nonprofit Model

Academic Case Study by:
Stefanos Zenios, Lyn Denend, Stacey McCutcheon
Published: 2012
[photo - IDRI]

The Infectious Disease Research Institute (IDRI) was founded by immunologist Steve Reed in 1993 as a nonprofit global health research center dedicated to applying advances in immunology to the development of products to prevent, detect, and treat neglected diseases. The institute was distinguished by its emphasis on the practical end goal of getting its products to market. To accomplish this, IDRI drew on the distinct competencies of diverse collaboration partners, including for-profit life science companies, research centers, universities, government organizations, and nongovernmental organizations (NGOs). Under the leadership of CEO H. Stewart Parker, IDRI was focused on eradicating tuberculosis, leishmaniasis, leprosy, malaria and Chagas disease, which together killed more than six million people each year.

To continue realizing positive results in the neglected disease space, IDRI needed a substantial, ongoing stream of funding. However, as a nonprofit, the organization could not tap into traditional funding sources available to private pharmaceutical firms, such as venture capital. IDRI generally relied on grants, but found that the funds were typically designated for a particular development program and had specific underlying rules governing their use. Accordingly, most grant support could not be used to develop IDRI’s infrastructure or to explore new projects that might enhance current research platforms. These funding constraints made sustaining the company challenging and limited its strategic growth. IDRI needed to generate additional revenue streams that would allow its management team more freedom in allocating funds to strategic, forward-looking activities. This mini-case study describes how Reed devised a model to create for-profit development arms to commercialize select IDRI vaccine technologies that had first-world applications, and thus significant profit potential, to help continue funding IDRI’s larger portfolio of projects.

[Read Case]

This story is part of the Global Health Innovation Insight Series developed at Stanford University to shed light on the challenges that global health innovators face as they seek to develop and implement new products and services that address needs in resource-constrained settings.  

Acknowledgements: We would like to thank H. Stewart Parker and Erik Iverson of IDRI for their participation. This research was supported by the National Institutes of Health grant 1 RC4 TW008781-01.

Photo credit: Courtesy of IDRI

Gradian I: Spinning Out a Commercial Entity from a Nonprofit Foundation

Academic Case Study by:
Stefanos Zenios, Lyn Denend, Julie Manriquez
Published: 2012
[photo - Gradian]

After observing too many unnecessary injuries and deaths caused by surgeries that were interrupted or canceled due to the unavailability of anesthesia, Dr. Paul Fenton designed a device called the Universal Anaesthesia Machine (UAM) that could deliver safe, reliable anesthesia even in the midst of a power outage. Fenton began using the prototype in his hospital in Malawi. When he saw how well the device performed in this environment, he sought to expand production so that other health facilities could benefit from the device. Unfortunately, Fenton was unable to convince investors to provide funding so he could further develop his innovation. He was also unsuccessful in identifying a buyer or licensee to bring the idea forward. At the time, those he spoke with were either hesitant to get involved in a business based in Africa, or they did not perceive an anesthesia machine targeted at low-resource healthcare providers to be commercially viable. Fenton would have to find another way to fund further development of the UAM.

This mini-case study describes how Fenton ultimately entered into an agreement with the Nick Simons Foundation to create Gradian Health Systems, which operates as a nonprofit but uses a commercial approach to sell the UAM at its manufacturing cost so production and dissemination of the device will become self-sustaining and widely scalable within several years.

[Read Case]

This story is part of the Global Health Innovation Insight Series developed at Stanford University to shed light on the challenges that global health innovators face as they seek to develop and implement new products and services that address needs in resource-constrained settings.  

Acknowledgements: We would like to thank Erica Frenkel of Gradian for her participation. This research was supported by the National Institutes of Health grant 1 RC4 TW008781-01.

Photo credit: Courtesy of Gradian Health Systems

Embrace: Deciding on a Hybrid Structure

Academic Case Study by:
Stefanos Zenios, Lyn Denend, Amy Lockwood, Stacey McCutcheon
Published: 2012
[photo - Embrace]

While attending Stanford, the Embrace team developed an idea for an innovative infant warmer to help low-birth-weight infants. The early prototype looked much like a sleeping bag for babies. While the form factor was unique, the real breakthrough was a reusable pouch of phase-change material that could be heated to 98-degrees Fahrenheit and maintain that temperature for several hours. When inserted into the sleeping bag, it would safely and reliably keep the baby warm. As designed, the warmer was small and light, transportable, and easy to use. Importantly, it also had the potential to be produced at a fraction of the cost of available incubators, even those already designed for the developing world.

Enthusiastic about the possibility of helping millions of low-birth-weight babies, the team decided to pursue their idea beyond the end of the course, creating a nonprofit called Embrace Global to further develop and commercialize the technology. Over time, however, the team discovered that it had underestimated the amount of time required to raise the needed capital to transition from a prototype to a market-ready product. After consulting with its board of directors, other advisors, and legal experts, the team thought that, at this stage in its development, becoming a for-profit or hybrid organization could position it for faster growth and greater scalability because it would be able to access larger sums of money in the form of equity investments. However, Embrace realized that as a company with private investors, who would be seeking a financial return on their invested capital, it could be more difficult for Embrace to justify targeting markets and customer segments that were considered small or otherwise unattractive by commercial standards. This mini-case study explores how Embrace decided to pursue a hybrid structure and the steps it took to balance these competing priorities in devising the new model.

[Read Case]

This story is part of the Global Health Innovation Insight Series developed at Stanford University to shed light on the challenges that global health innovators face as they seek to develop and implement new products and services that address needs in resource-constrained settings.  

Acknowledgements: We would like to thank Jane Chen of Embrace for her participation. This research was supported by the National Institutes of Health grant 1 RC4 TW008781-01.

Photo credit: Courtesy of Embrace

CycleBeads II: Creating a Dual Market

Academic Case Study by:
Stefanos Zenios, Lyn Denend, Julie Manriquez
Published: 2012
[photo - Cycle Beads]

To help address the issue of unplanned pregnancy and maternal mortality in the developing world, researchers at the University of Georgetown’s Institute for Reproductive Health (IRH) recognized the need for an intuitive, natural contraception method that could meet the needs of families that chose not to use medical or surgical alternatives. IRH developed the Standard Days Method (SDM), a simple natural family planning system that could be implemented in all countries and cultures across the globe. In addition, the team created CycleBeads to provide a visual, tangible tool to help women follow the method.

To manufacture, sell, and distribute the product, Cycle Technologies licensed the CycleBeads product from IRH and partnered with the organization to bring it to market. Cycle Technologies’ goal for SDM and CycleBeads was to reach users in developing countries where medical and surgical contraception options were limited or unacceptable, as well as those in developed regions where women wanted effective, non-invasive birth control and proactive family planning tools. The first reason for this dual objective was to help establish the credibility of the product. The second reason was that Cycle Technologies hoped to leverage sales in U.S. and other western markets as a mechanism for creating a viable business. This mini-case study describes how Cycle Technologies approached the challenge of establishing a dual market.

[Read Case]

This story is part of the Global Health Innovation Insight Series developed at Stanford University to shed light on the challenges that global health innovators face as they seek to develop and implement new products and services that address needs in resource-constrained settings.  

Acknowledgements: We would like to thank Victoria Jennings of the Institute for Reproductive Health and Leslie Heyer of Cycle Technologies for their participation. This research was supported by the National Institutes of Health grant 1 RC4 TW008781-01.

Photo credit: Courtesy of Cycle Technologies

 

Brilliance II: Achieving Impact Through Licensing

Academic Case Study by:
Stefanos Zenios, Lyn Denend, Julie Manriquez
Published: 2012
[photo - Brilliance]

When team members at D-Rev — a U.S. nonprofit technology company with the mission to improve the health and incomes of people living on less than $4 per day — became interested in the problem of infant jaundice, they initiated a detailed assessment of the phototherapy landscapes in India and Nigeria. Based on insights from that research, the D-Rev team created a prototype for a jaundice treatment product that it called Brilliance. The new phototherapy solution used a high-intensity LED light source that consumed less power than devices with compact fluorescent bulbs (the current standard) and lasted significantly longer. Early test results also revealed that the technology had the potential to perform on par with or better than state-of-the-art phototherapy equipment. 

When D-Rev was ready to start thinking about taking Brilliance to market, the team carefully evaluated its own competencies and concluded that the organization’s strengths were not in product manufacturing or after-sales services. D-Rev did not have the vast expertise and connections needed to establish a sales and distribution network in India, which was its preliminary target market for the device. The team believed it should enter into a licensing agreement to accelerate Brilliance’s market penetration. The challenge was to find the right partner and structure the partnership deal effectively to ensure that D-Rev’s social impact goals would be achieved. This mini-case study explores how D-Rev identified its partner and crafted an agreement to motivate desired behavior.

[Read Case]

This story is part of the Global Health Innovation Insight Series developed at Stanford University to shed light on the challenges that global health innovators face as they seek to develop and implement new products and services that address needs in resource-constrained settings.  

Acknowledgements: We would like to thank Krista Donaldson and Jayanth Chakravarthy of D-Rev for their participation. This research was supported by the National Institutes of Health grant 1 RC4 TW008781-01.

Photo credit: Courtesy of D-Rev

Anacor: Neglected Disease R&D Within a For-Profit Model

Academic Case Study by:
Stefanos Zenios, Lyn Denend, Stacey McCutcheon
Published: 2012
[photo - Anacor]

Anacor Pharmaceuticals, Inc. is a for-profit biotech firm founded in 2002, which focuses on discovering, developing, and commercializing novel small-molecule therapeutics derived from a unique boron chemistry platform. While performing early disease screening, Anacor discovered that this platform showed activity against the causative agents of several neglected bacterial and parasitic diseases. Although CEO David Perry felt a responsibility to apply this technology to the neglected disease space, the company was venture-backed and pre-revenue. As a result, devoting time and money to the pursuit of new therapies for complex, unprofitable global health markets would create a conflict with the objectives of its investors. 

Despite these constraints, Perry was intrigued by the possibility of applying Anacor’s platform to neglected diseases because he, like many others, perceived a need for real innovation in the global health space. This mini-case study describes how Perry and Eric Easom, who became the company’s Program Leader for Neglected Diseases, devised a plan to leverage non-dilutive funding sources to underwrite this important work and the benefits it creates for the company.

[Read Case]

This story is part of the Global Health Innovation Insight Series developed at Stanford University to shed light on the challenges that global health innovators face as they seek to develop and implement new products and services that address needs in resource-constrained settings.  

Acknowledgements: We would like to thank Eric Easom of Anacor for his participation. This research was supported by the National Institutes of Health grant 1 RC4 TW008781-01.

Photo credit: © Juan Carlos Tomasi; reprinted with permission

SafePoint II: Sustaining Adoption

Academic Case Study by:
Stefanos Zenio, Lyn Denend
Published: 2011
[photo - SafePoint]

After reading a newspaper article that predicted the spread of HIV through medical syringes, 

Marc Koska committed himself to addressing the threat of unsafe injections. He spent nearly 10 years in the field, investigating all aspects of the problem: clinical behavior, drug use, patient activity, syringe manufacturing/molding, distribution, disposal, procurement, public health, policy, and funding. The result was the K1 Auto Disable (AD) syringe, which physically prevents reuse by locking the plunger once it has been fully depressed. 

To help raise awareness about the dangers of needle reuse and help stimulate demand for AD syringes, Koska founded a nonprofit called the SafePoint Trust. One of SafePoint’s first activities was to launch an aggressive public awareness campaign in India. As a result of the effort, 26 states in the country switched to using only AD syringes in their public health facilities. 

Unfortunately, this change didn’t stick, with several states reverting to the use of regular syringes over time. This mini-case study describes how Koska modified his approach to driving adoption of AD syringes as SafePoint expanded its program to Tanzania. By devising a more comprehensive adoption strategy, he hoped to create more sustainable results in that country.

[Read Case]

This story is part of the Global Health Innovation Insight Series developed at Stanford University to shed light on the challenges that global health innovators face as they seek to develop and implement new products and services that address needs in resource-constrained settings. 

Acknowledgements: We would like to thank Marc Koska of the SafePoint Trust for his participation. This research was supported by the National Institutes of Health grant 1 RC4 TW008781-01.

Photo credit: © SafePoint

SafePoint I: Stimulating Adoption

Academic Case Study by:
Stefanos Zenios, Lyn Denend
Published: 2011
[photo - SafePoint]

After reading a newspaper article that predicted the spread of HIV through medical syringes, Marc Koska committed himself to addressing the threat of unsafe injections. He spent nearly 10 years in the field, investigating all aspects of the problem: clinical behavior, drug use, patient activity, syringe manufacturing/molding, distribution, disposal, procurement, public health, policy, and funding. The result was the K1 Auto Disable (AD) syringe, which physically prevents reuse by locking the plunger once it has been fully depressed. 

Convinced he had a breakthrough on his hands, Koska shopped the product to the major syringe manufacturers. Unfortunately, these producers understood the need for such a device, but did not believe there was adequate demand to warrant the investment required to produce, sell, and distribute it. Koska gradually convinced organizations such as UNICEF to become customers of the AD syringe, but sales of the device were not growing fast enough to make a real impact. This mini-case study describes why Koska started the nonprofit SafePoint Trust to raise awareness about unsafe injections, as well as the dramatic campaign he launched in India to stimulate the adoption of AD syringes.

[Read Case]

This story is part of the Global Health Innovation Insight Series developed at Stanford University to shed light on the challenges that global health innovators face as they seek to develop and implement new products and services that address needs in resource-constrained settings. 

Acknowledgements: We would like to thank Marc Koska of the SafePoint Trust for his participation. This research was supported by the National Institutes of Health grant 1 RC4 TW008781-01.

Photo credit: © SafePoint

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